Cardiorespiratory Practical Skills

Question 1

What are the indications for O2 therapy?

Answer 1

• Acute respiratory failure
• Low cardiac output states
• Increased metabolic demands
• Post-surgical

Question 2

What is Type I and Type II respiratory failure?

Answer 2

Type I = hypoxia without hypercapnia

Type II = hypoxia with hypercapnia

Question 3

Precautions for O2 therapy?

Answer 3

• Hypoxic drive
• Oxygen toxicity (lung damage resulting from too much supplementary oxygen)
• Retrolental fibroplasia (disease of the premature eye)
• Fire

Question 4

What is the percentage of oxygen delivered via nasal specs for the following:

a) 1L/min
b) 2L/min
c) 3L/min
d) 4L/min
* *over 6L can cause dryness/discomfort

Answer 4

a) 1L/min = 22%
b) 2L/min = 24%
c) 3L/min = 26%
d) 4L/min = 28%

Question 5

What is anatomical dead space?

Answer 5

The volume of conducting airways. This does not change.

Question 6

What is the normal tidal volume of an adult?

How much of this is anatomical dead space?

Answer 6

450-600ml

150ml of dead space

Question 7

What is physiological dead space?

Answer 7

When a disease or condition obstructs the alveolar space (anatomical areas of diffusion)

Question 8

What is spirometry?

Answer 8

A physiological test that measures the maximal volume of air that an individual can inspire and expire with maximal effort.

Question 9

What is:

a) FVC
b) FEV1

Answer 9

a) FVC = volume delivered during a forceful expiration (from full inspiration)
b) FEV1 = expiratory volume in the first second of an FVC manoeuvre

Question 10

What are the instructions for teaching the patient how to do a spirometry test?

Answer 10

1) Attach nose clip
2) Take a maximum inspiration, steady pace, “more, more, more”
3) Seal mouth tightly around mouthpiece
4) Expire; “blast as hard, fast & for as long as possible”, “keep going, keep going”
5) Rest & then re-test

Question 11

How to check if a spirometry test is good quality?

Answer 11

3x ‘satisfactory tests’
Two largest FVC values must be <0.150L
Two largest FEV1 values must be <0.150L

Question 12

When you achieve 3 reproducible spirometry results, what data is recorded?

Answer 12

The best result of 3.

Question 13

What is the FEV1 : FVC ratio important for?

Answer 13

Gives diagnostic information regarding the classification of pulmonary disease.

Question 14

What are the FEV1:FVC values for the following classifications:

a) Normal
b) Obstructive
c) Restrictive

Answer 14

a) Normal = 75-85%
b) Obstructive = <70% (reduced FEV1 due to obstruction)
c) Restrictive = 75-85% (FEV1 and FVC reduced)

Question 15

If an obstructive disease is identified, what are the following severities rated by? (FEV1)

a) MILD
b) MODERATE
c) SEVERE
d) VERY SEVERE

Answer 15

a) MILD = FEV1 > / = 80% of predicted
b) MODERATE = FEV1 50-80% of predicted
c) SEVERE = FEV1 30-50% of predicted
d) VERY SEVERE = FEV1 < 30% of predicted

Question 16

What is a peak expiratory flow meter?

Answer 16

A monitoring device for peak expiratory flow rate.

Question 17

What are the instructions for a peak flow meter test?

Answer 17

1) Hold device horizontally and clear fingers from scale.
2) Take maximal breath in.
3) Breath out as HARD and FAST as you can.

Question 18

A peak flow drop below __% of a patients best PEF means they should consult their asthma action plan.

Answer 18

80%

Question 19

What is the V/Q matching at each lung region:

a) Apex
b) Middle
c) Lower

Answer 19

a) Apex = V > Q
b) Middle = V = Q
c) Lower = V < Q

Question 20

The diaphragm provides __% of inspiratory effort and has a major effect on ventilation.
*thus, those with impaired diaphragm movements should be encouraged to perform diaphragmatic movements eg. post-abdo Sx

Answer 20

70

Question 21

What are TEEs?

What are they used for?

Answer 21

Thoracic Expansion Exercises

They are used to try to increase lung volumes, reduce atelectasis/lobar collapse, remove secretions & assist with cough.

Question 22

What are the mechanisms of action for TEEs/SMIs?

Answer 22

1) Collateral airflow via collateral channels: air movements from areas of high pressure to low, expanding collapse alveoli
2) Interdependence theory: inflating alveoli pulls on the adjacent alveoli

Question 23

Instructions for a TEE set:

Answer 23

1) Relax shoulders and upper chest
2) Take in a slow, deep breath (6 seconds), expanding ribs against hands
3) Hold for 1-2 seconds
4) Breath out slowly
5) *optional squeeze at the end of expiration to facilitate next inspiration

Question 24

What is the usual prescription for TEEs?

Answer 24

3-4x consecutive TEE breaths
Rest
Repeat until 10-12 breath total eg. 3x sets with 4x reps
Can repeat hourly whilst awake.

Question 25

What is an SMI? | What is it used for?

Answer 25

Sustained maximal inspiration; TEE + a sniff at maximal inspiration Uses as per TEE

Question 26

What is the usual prescription of SMI's?

Answer 26

2x TEE's followed by 1xSMI Break Repeat to achieve 10-12 breaths Can be hourly whilst awake

Question 27

What is incentive spirometry? | Examples?

Answer 27

A device which encourages patients to take a sustained maximal inspiration through visual feedback. Eg. Triflow, Voldyne

Question 28

Explain the procedure for using a Voldyne.

Answer 28

1) Slow, deep inspiration through mouthpiece 2) Aim to get marker as high as possible * Can set target * Left chamber has 'good, better. best' ranges to cue SLOW inspiration * make sure marker returns to bottom before second breath to avoid 'stacking'

Question 29

What is the usual prescription for Voldyne or Triflow?

Answer 29

10-12 breaths (3-4sets), hourly | with sufficient rests

Question 30

Explain the technique for using a Triflow?

Answer 30

1) Slowly and deeply inspire 2) Aim to get first 2x balls up to top for a couple of seconds 3) Third ball should NOT be raised, if so the breath is too fast

Question 31

What are the main secretion clearance techniques?

Answer 31

1) Cough 2) Huff & FETs 3) ACBTs

Question 32

What is a cough?

Answer 32

A deep inspiration followed by a forced expiratory manoeuvre performed against a closed glottis

Question 33

Expiratory flow needs to be at least __% greater than inspiratory flow to get secretion clearance by annular flow.

Answer 33

10

Question 34

A cough may be assisted by:

Answer 34

- Upright positioning - Increasing inspiratory capacity - Manual overpressure/support - Sip of water

Question 35

How to describe a cough?

Answer 35

- Strong/weak - Dry/moist - Effect/ineffective - Productive/non-productive

Question 36

High vs Low volume huff?

Answer 36

``` High = clears secretions from trachea and larger airways Low = clears secretions from smaller periphery airways ```

Question 37

What is the procedure for FETs?

Answer 37

1) Position patient upright or in well supported GAP 2) Teach LVH 3) 30sec-1min breathing control 4) 1-2 LVHs 5) BC 6) LVH or HVH (may cause cough) 7) BC 8) Continue until FETs sound 'dry'

Question 38

What is the procedure for ACBT?

Answer 38

1) Position in sitting or GAP 2) 30sec-1min BC 3) 3-4x TEEs (1-2sec hold) 4) BC 5) FET; start with LVH, later may choose HVH, and then cough 6) BC Repeat